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[Page: H10892] GPO's PDF---
The SPEAKER pro tempore. Under the Speaker's announced policy of January 6, 1999, the gentleman from New Jersey (Mr. PALLONE) is recognized for 60 minutes as the designee of the minority leader.
Mr. PALLONE. Mr. Speaker, this evening I am going to be joined with some of my colleagues on the Democratic side of the aisle to discuss health care and what we believe should be done in the waning days of this Congress. Unfortunately, most of what we are about to discuss is part of the unfinished agenda here which I have been somewhat critical of the Republican leadership in the House of Representatives for because these health care issues have not been resolved; yet they
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When I talk about health care concerns, I believe that they are the Nation's number one priority right now. They concern matters that affect the daily lives of our constituents and which I think, if they were resolved and if they were attended to by the Republican leadership and passed and sent to the President in legislative form, would actually make a difference in people's lives. So for that reason I regret that on the issues such as prescription drugs for seniors under Medicare, HMO reform, and also increasing access to health care for those who are uninsured this Congress really has not accomplished much.
I do not really expect much to be accomplished in the next few days that we are here, but I do think it is unfortunate that the Republican leadership has so far, and has over the 2 years, refused to address these issues in a meaningful way.
I just wanted to summarize, if I could, and put them also in the context of the presidential debate, because I think that health care policy has really been one of the defining issues in the context of the presidential debate and the presidential campaign.
Let me mention first the issue of prescription drugs. We know that our senior citizens and the disabled, people who currently are eligible for Medicare, many of them do not have access to prescription drugs because it is not a basic benefit under the Medicare program. What the Democrats have been saying is that we would like it to be a basic Medicare benefit. We would like it to be included under the rubric of the Medicare program because we know that Medicare has been very successful in addressing the problems of hospital care, the need for hospital care and the need for physicians' care.
If a person now reaches the age of 65 or is eligible because they are disabled, they do get their hospital insurance taken care of under Medicare. And if they pay a certain amount a month, about $40 or so per month, then they have also their physician's care taken care of. But that is not the case with prescription drugs. Some seniors are able to get a prescription drug benefit if they are fortunate enough to have an HMO in their area that may cover it in some way. But that is not the majority.
Some senior citizens outside of Medicare are able to get coverage because they have it as part of an employer retirement plan or maybe they are eligible for veterans benefits as part of the Federal Government; but generally most seniors do not get either adequate prescription drug coverage or, in many cases, no prescription drug coverage at all.
Basically, using the example of Medicare part B for physician's care, what the Democrats have been saying and what Vice President GORE has been saying is that we will establish a new part D, for example, under Medicare. And just like with part B for the physician's care, seniors would pay so much per month. It would probably start as little as $25 a month; but as the benefits increase, it might get to be more. They would then get a certain prescription drug benefit that would be guaranteed, which would make it possible for them to simply go to their local pharmacy, and it would be covered. They would have a choice of a pharmacy to go to, and any prescription drug that is recommended by their physician or by the pharmacist as medically necessary would be covered.
Very simple concept, really. No magic here. It is simply included under the Medicare program. Well, the Republican leadership and the Republican presidential candidate, Governor Bush, do not like this. I think, frankly, though they may not admit it, that they do not like Medicare very much, and they do not like the idea of a public program like Medicare including prescription drugs. So what they propose I call a voucher. Basically, they say they are going to give a certain amount of money in the form of a subsidy or a voucher to seniors who are below a certain income, not the majority of seniors, but just those who are below a certain income. Those seniors can take this voucher, and they can go out in the private marketplace to see if they can find an HMO or some other kind of insurance plan that will cover them.
There are a lot of problems with that. First of all, it is not under Medicare, so it is not going to be universal. Most seniors would not be able to take advantage of it. In addition to that, with the exception of the HMOs, they are probably not able to buy a prescription drug policy. Most insurance companies do not sell prescription drug policies. So they may be able to get it through an HMO, but we know what the problems are with HMOs. We do not know how much the deductible is going to be; we do not know how much the copayment is going to be. We do not know whether all drugs will be covered. A lot of problems and a lot of inability, I would say ultimately, to get a good insurance program that covers prescription drugs.
So I would suggest that this Republican proposal and the one that comes from Governor Bush is not realistic. It is not something that is going to help most seniors. But even so, basically they have not paid a lot of attention to it here in the House of Representatives. They talked about it at one time, but that was it. There has not really been any movement to get this accomplished. That is unfortunate, because our seniors are crying out for an answer on the issue of prescription drugs.
Now, on a second issue, and that is the issue of HMO reform, once again the Democrats, and if we listened to the last debate, Vice President GORE was very specific that what we need in order to cure the abuses in the HMO system is the Patients' Bill of Rights, the Norwood-Dingell bill that was passed by the House of Representatives, mostly with Democratic votes but with some Republican support.
I will not get into all the details of the Patients' Bill of Rights, but basically it changes a lot of things that exist under current law in terms of the abuses we face with HMOs. Right now, the decision about what kind of medical care a person gets, whether that person gets a particular operation, how many days they stay in the hospital, what kind of equipment they get, these decisions are made by the insurance company, and many times without the patient's input or without the doctor's input. That is what leads to abuses.
HMOs deny care. People do not really have a way to redress their grievances because if they have to appeal the decision of the HMO, usually it is to the HMO itself, and they, of course, deny it again.
[Time: 20:45]
What the Democrats have been saying with the patients' bill of rights, with the support of a minority of Republicans but not with the Republican leadership, is that we have been saying that we want to make sure that decisions about what kind of care they get, what is medically necessary, are made by the physician and the patient, not by the insurance company. That is what the patients' bill of rights says.
And secondly, it says that if the HMO denies them care that they think they should have or that they need, then they have a legitimate way of redressing their grievance by going into an outside board that is independent of the HMO, or, failing that, they have the right to go to court and bring suit, which is not possible now for most people who are in HMOs.
Well, if we listen to the third debate, Governor Bush said that he was in favor of HMO reform. But then when we look at his record in Texas, on one occasion when something like the patients' bill of rights came to his desk, he vetoed it. And then on another occasion when it came to his desk he basically was told, if you veto it again, we will override your veto, we have the votes in the legislature to override; and so, he let it become law without his signature, basically protesting it but indicating that he could not do anything about it because if he did veto it, it was going to be sustained anyway.
So we do not have much support here. We have a Presidential candidate on the Republican side that basically opposed HMO reform as Governor. And then we have a Republican leadership that still reluctantly allowed the patients' bill of rights to come to the floor of the House and it passed, but the Senate is holding it up and the Republican leadership continues to oppose it here in the House of Representatives.
The last major issue, and there are others but I want to get to my colleagues, the last major issue with regard to health care reform that faces
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Well, the Democrats have been saying, let us try to solve that problem. We solved it to some extent in a significant way with children, which was the largest of this 44 million who did not have insurance . We passed the CHIP bill, and we gave money to the States so they could sign up kids for a health insurance program for the children of working parents. And that has been successful in probably signing up about half the children around the country that were previously uninsured.
But again, when it came to Governor Bush, he said that, although he was getting the money from the Federal Government, he wanted to keep the income levels for the kids' care program, for the CHIP program fairly low. And he had originally proposed, I think, 150 percent of poverty, and it took the Texas legislature basically to insist that the eligibility requirements be higher than that. And for a long time, essentially, he made it difficult for the CHIP program, for the Children's Health Insurance Program, to be implemented in the State of Texas in a way that would be helpful to more and more children.
Now, what the Democrats have been saying and what Vice President GORE has been saying is we want to expand the eligibility for this CHIP program to even higher incomes, maybe 250 percent of poverty. And at the same time, the Vice President and the Democrats have been saying we want to address the problem with the adults who are uninsured, so let us let the parents of the kids who are in the CHIP program enroll in the CHIP program as well so that they are insured. It certainly makes a lot of sense. But again, we do not see the Republicans supporting that initiative or taking any action here in the House of Representatives to address that concern.
Lastly, the other large group of people that we know are uninsured are the near elderly, the people between 55 and 65 that are not eligible for Medicare but who often lose their job or take early retirement and find themselves or their spouse without health insurance .
President Clinton and Vice President GORE and the Democrats have been advocating that those near elderly be able to buy into Medicare for maybe $300 or $400 a month, and again we have seen opposition from the Republican leadership and the unwillingness to bring this up in committee or on the floor of the House.
So whether it is the issue of access and covering the uninsured, whether it is the issue of HMO reform, or whether it is the issue of prescription drugs, over and over again the Democrats have put forward proposals supported by the Vice President which have been opposed or scuttled, if you will, by the Republicans and again not supported by their Presidential candidate, Governor Bush.
We are only pointing out the facts here tonight. I am joined by a number of my colleagues who would like to address this issue.
First, I would like to yield to the gentlewoman from the Virgin Islands (Mrs. CHRISTENSEN) who also happens to be a physician.
Mrs. CHRISTENSEN. Mr. Speaker, I thank the gentleman for yielding.
Mr. Speaker, as my colleague the gentleman from New Jersey (Mr. PALLONE) said, the big issues that remain before us as we come close to the end of the 106th Congress are the same ones that we have not been able to get the Republican leadership of this body to adequately address through several Congresses, not just this one, education and health care.
Last week I was able to join some of my colleagues to call for passage of our education agenda. But tonight I want to join my colleague in talking about health care.
A few weeks ago, I joined Senator BYRON DORGAN of North Dakota, along with the gentleman from Arkansas (Mr. BERRY) and others at a hearing in the other body to call on their leadership to bring the patients' bill of rights to the floor for a vote and to pass it. To date nothing has happened. That is despite the testimony of patients, of a mother who lost her daughter because she was denied the test and care that she needed, the testimony of health care professionals who said how their professional judgment and their values were daily compromised by having to work under the current managed care system.
The system has to be reformed to allow doctors and other providers to make decisions in consultation with their patients on what medical tests and care is indicated in each instance, to have the system better respond to the needs of patients for access to emergency services and specialists, and to make those who are making decisions on health care to be accountable for those decisions.
People all over this country are dissatisfied with managed care. They want the system revamped. They want a patients' bill of rights. The Vice President is poised to make that happen and we, their Representatives, need to respond.
I want to spend the rest of my time on the Medicare give-backs that are being proposed as a remedy for the cuts that took place in the Balanced Budget Amendment of 1997. It is important that, in this measure, the one that is proposed, those who are on the front lines providing health care to those in need be treated fairly and be given precedence since they are the ones who have suffered the most along with the patients who rely on them for service.
In my district, our only private home care agency was forced to close and our public health agency forced to cut back because of the cuts that were imposed in BBA 1997. This is a situation that has been repeated in towns, cities and rural areas around the country. Our hospitals and nursing homes in the Virgin Islands are lucky to still be open, although it has been a struggle to continue to provide care. Others have had to close their doors.
I want to say to the Nation's hospitals, do not accept the Trojan Horse that is being offered to you. The recommendation as it now stands is wrong. Do not let us be picked off one by one and pitted against each other. We can all win if we stand together on this issue.
As a doctor, I know how difficult it is to meet overhead costs and to keep providing services when the fees keep getting smaller. Our expenses and our operating overhead are not going down. They are going up. Our patients need, at the very least, the same level of care, and they deserve to have their needs met.
I resent the fact that the Republican leadership wants to give HMOs any part of that give-back. For what? They promise nothing in return. They have left Medicare patients, our elderly, stranded because they could not make the desired profit. They are holding out their hands for more money now, and they are not even being made to increase the service to the special population.
For too long, HMOs have been allowed to take the care out of ``health care,'' and we say enough is enough. We need to give the dollars back to the providers of health care, to the doctors and nursing homes, hospitals and home health care agencies. The people of this country deserve the full range of health services, and giving our providers fair reimbursements and helping them to stay in business makes that possible. We in the Democratic Caucus say give the money to those who care, give it to the providers, not to the HMOs.
I must also mention an issue that is important to my district. That is the increases in Medicaid that the administration is seeking and the redistribution of the Children's Health Insurance Program funds that are not used by the States. In my district and the other territories, we have a cap on our Medicaid dollars; and we receive CHIP funds under a formula which does not allow us to provide the level or the scope of health care that our residents need. With our cap, we are unable to provide Medicaid to people even at the poverty level. So we have a large gap between those who are covered by Medicaid and the uninsured.
The Journal of the American Medical Association
today reported a study on uninsured adults showing that when
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In my district, close to one-third of the children are estimated to be uninsured. Kids count. The Community Foundation of the Virgin Islands recently released a report that showed that 41 percent of our children live in poverty, twice the national rate, and that deaths among Virgin Islands children under 14 are also nearly twice the national rate.
Health care is a right for all, not a privilege for the few. We have to get that straight before we adjourn and leave for this election.
This means passing a meaningful patients' bill of rights. It means adding prescription drug coverage to Medicare. It means making up for the damage we have done to hospitals, home health agencies, nursing homes, doctors and other providers with the cuts in 1997. And it means making CHIP and Medicaid fair and equitable to all Americans.
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